Provider Demographics
NPI:1134712854
Name:MAHER, FLORISSA C
Entity type:Individual
Prefix:MISS
First Name:FLORISSA
Middle Name:C
Last Name:MAHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GLENLAKE PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3495
Mailing Address - Country:US
Mailing Address - Phone:678-856-8765
Mailing Address - Fax:678-222-3401
Practice Address - Street 1:10 GLENLAKE PKWY STE 130
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3495
Practice Address - Country:US
Practice Address - Phone:678-222-3487
Practice Address - Fax:678-222-3401
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-13
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHCP010969251J00000X
GA010969253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA010969OtherPHCP